Provider Demographics
NPI:1669596862
Name:STANLEY, MYRL S (CRNFA)
Entity type:Individual
Prefix:
First Name:MYRL
Middle Name:S
Last Name:STANLEY
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1916
Mailing Address - Country:US
Mailing Address - Phone:541-812-4000
Mailing Address - Fax:541-812-4007
Practice Address - Street 1:950 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3415
Practice Address - Country:US
Practice Address - Phone:541-928-5851
Practice Address - Fax:541-928-5138
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088000232RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR088000232RNOtherNURSING LICENSE